{"id":407,"date":"2015-09-08T20:24:23","date_gmt":"2015-09-08T20:24:23","guid":{"rendered":"http:\/\/stories.kera.org\/surviving-ebola\/?p=407"},"modified":"2015-09-24T16:09:43","modified_gmt":"2015-09-24T16:09:43","slug":"learning-from-mistakes-north-texas-hospitals-make-changes","status":"publish","type":"post","link":"https:\/\/stories.kera.org\/surviving-ebola\/2015\/09\/08\/learning-from-mistakes-north-texas-hospitals-make-changes\/","title":{"rendered":"Learning From Ebola Mistakes, North Texas Hospitals Make Changes"},"content":{"rendered":"

A year after Ebola arrived in Dallas, it might seem like hospitals and clinics are back to normal \u2013 except for the leftover hand sanitizer pumps and the occasional sign warning about international travel. But, underneath the surface, there are larger shifts in health care in how nurses and doctors work together, and how hospitals are preparing for whatever is the next Ebola.<\/em><\/p>\n

\n

Let\u2019s start where Ebola began in the U.S.\u00a0— the room at Texas Health Presbyterian\u2019s <\/a>emergency department where Thomas Eric Duncan lay sick with Ebola.<\/p>\n

Even though it\u2019s been one year since Duncan was in this room, the stigma is so strong the hospital doesn\u2019t want to reveal the room number.<\/p>\n

Once again, in the tug of war between fear and science, emotion pulls harder.<\/p>\n

Dr. Daniel Varga, chief clinical officer at Texas Health Resources, said even though staff was aware of Ebola in 2014, no one thought it would happen in Dallas.<\/p>\n

\u201cWe believe we were very well attuned to the potential risk of Ebola, and that we had communicated that fairly aggressively,” Varga said. “What we didn\u2019t do is train and simulate for that.\u201d<\/p>\n

\"Dr.

Dr. Daniel Varga is chief clinical officer at Texas Health Resources. Photo\/Lauren Silverman<\/p><\/div>\n

Now the hospital is emphasizing training to prevent confusion. For example, when the state of Texas issued new guidelines on how to put on and take off personal protective gear, administrators didn\u2019t just hand out an instruction sheet for nurses to read in their free time.<\/p>\n

\u201cWe\u2019re actually training people in donning and doffing the garment,” Varga said. “That\u2019s a major change for us in terms of how things were set up a year ago.\u201d<\/p>\n

That sounds small. But remember that the tiniest mistake while removing those protective suits can mean coming down with Ebola.<\/p>\n

That\u2019s the theory behind what happened to Presbyterian nurses Nina Pham and Amber Vinson.<\/p>\n

\u201cWe believe we were very well attuned to the potential risk of Ebola, and that we had communicated that fairly aggressively. What we didn\u2019t do is train and simulate for that.”
Dr. Daniel Varga, chief clinical officer at Texas Health Resources<\/div>
<\/div><\/div>\n

What happened at Presbyterian<\/h4>\n

Communication on policies and procedures, as well as among staff, was one of the critical flaws cited by an independent panel that reviewed what went wrong at Texas Health Presbyterian Hospital.<\/p>\n

In response, nurses, doctors and scribes who take notes now work in \u201cpods\u201d or teams. All wear a small black device with a grey button around their neck.<\/p>\n

Nurse Misty Cogburn uses it to find a colleague. Doctors who used to see 55 patients at a time are now treating a dozen, she said.<\/p>\n

\"Misty

Misty Cogburn is an emergency department nurse manager at Texas Health Presbyterian Hospital in Dallas. Photo\/Lauren Silverman<\/p><\/div>\n

\u201cThe physician, the nurse and the scribe will come together and do the discharge together so they can ask any additional questions,” Cogburn says. “The whole team is involved.\u201d<\/p>\n

That\u2019s to help prevent mistakes like the one with Thomas Eric Duncan. He was sent home after his first ER visit. Although Duncan, who had a fever above 100 degrees, did tell a nurse he had recently traveled from Africa, that information wasn\u2019t verbally communicated to the doctor.<\/p>\n

Here\u2019s the thing: Even if the physician didn\u2019t know Duncan\u2019s travel history, there was another red flag that should have kept the doctor from sending him home. It\u2019s called a SIRS<\/a>, or sepsis score, and it essentially measures when a patient is likely to develop a life-threatening complication from an infection.<\/p>\n

“When the SIRS score for Mr. Duncan got to 3 or higher and was highlighted in red, the reassessment that we would hoped would have happened, to go back and find out why has Mr. Duncan\u2019s SIRS score gone to 3 or 4, and what should we do before we send him home, didn\u2019t happen,” said\u00a0Dr. Jeffrey Canose, chief operating officer at Texas Health Resources.<\/p>\n

Today, if a patient hits a high score, it triggers multiple alerts and staffers know to respond, Canose says.<\/p>\n

\u201cI would like to think it wouldn\u2019t happen to another caregiver, but there are no guarantees. But I think we\u2019re in a better place than we were.\u201d
Cindy Zolnierek, executive director of the Texas Nurses Association, on whether another American nurse could contract Ebola<\/div>
<\/div><\/div>\n

 <\/p>\n

\"Employee

An employee at the emergency department at Parkland Hospital. The hospital remains on alert for Ebola, an official says. Photo\/Lauren Silverman<\/p><\/div>\n

After Ebola, many lessons learned<\/h4>\n

So far, all the lessons learned are meant to help identify people with Ebola, not treat\u00a0them.<\/p>\n

That\u2019s because — in perhaps the biggest change from last year — Presbyterian, or any other hospital in North Texas, won\u2019t be treating Ebola patients.<\/p>\n

\u201cWhile I think the care of an Ebola patient is well within the scope, there\u2019s such an overwhelming impact to the rest of operations and the safety of patients and caregivers that cohorting them makes the most sense,” Varga said.<\/p>\n

The federal government has identified 55 hospitals to transfer people with emerging infectious diseases like Ebola — including two in Texas. Right now, those places are the University of Texas Medical Branch at Galveston<\/a> and Texas Children’s Hospital<\/a> in Houston.<\/p>\n

There could be another Ebola treatment center established in North Texas. A location hasn\u2019t been chosen, but the new $1.3 billion Parkland Hospital<\/a> has been tossed around as an idea.<\/p>\n

\"Parkland

Parkland Hospital in Dallas. Photo Credit\/Parkland<\/p><\/div>\n

Dr. Alexander Eastman is chief of the trauma center at Dallas County’s public hospital. He’s responsible for disaster preparedness. He says Parkland is still on high alert, asking every new patient about travel history to screen for infectious diseases.<\/p>\n

\u201cWhether it be Ebola or now we\u2019re working on looking at some of the others that are out there to date, we\u2019ve screened almost 1.5 million people,” Eastman said. “I know it\u2019s enough to keep people from slipping through the cracks. It’s about whether the screening tool is used effectively and of course it requires the patient to be honest and to disclose that they have potentially been somewhere, which is an important factor.”<\/p>\n

And out of the million-plus people Parkland has screened, some have come up positive, but none turned out to have Ebola. Getting results for a blood test though is much faster and easier than it was last year. Today, samples are examined in Dallas instead of having to be sent to Austin.<\/p>\n

And minutes matter when it comes to infectious diseases like Ebola. To cut down on treatment time, John Peter Smith Hospital in Fort Worth<\/a> has supply carts ready to roll if a patient screens positive for an infectious disease.<\/p>\n

\u201cWe can pull a room together in a moment\u2019s notice should we have a patient show up in our ED,\u201d said Wanda Peebles, chief nursing officer at JPS.<\/p>\n

\"Kent

Dr. Kent Brantly was the first patient with Ebola to be treated at a hospital in the United States. Photo\/ Samaritan\u2019s Purse<\/a><\/p><\/div>\n

JPS has a unique tie to Ebola. Dr. Kent Brantly, the first patient with the deadly virus to be treated at a hospital in the United States, did his\u00a0medical residency\u00a0at the Fort Worth hospital.<\/p>\n

When he got sick in Liberia, \u201cit gave you a sense this can happen to anyone,” Peebles said. “When it is one of your own, it really brings it closer to home.”<\/p>\n

‘We’re in a better place’<\/h4>\n

The three people with Ebola in Texas served as a valuable reminder.<\/p>\n

\u201cThis time it was Ebola, it could be something else, another disease that pops up that we\u2019re not aware of at this point,” Peebles said. “This training has prepared us for whatever may come through our door that\u2019s an infectious disease.\u201d<\/p>\n

Would nurses like Nina Pham and Amber Vinson have gotten sick today?<\/p>\n

Last year, tens of thousands of nurses across the country protested for better safeguards against Ebola.<\/p>\n

More than 7,000 nurses are members of the Texas Nurses Association. Executive Director Cindy Zolnierek said training has improved.<\/p>\n

\u201cI think hospitals have responded, many with a core team that is specially trained and has drilled in the preparation, particularly in the removal of protective equipment,” Zolnierek said. “I would like to think it wouldn\u2019t happen to another caregiver, but there are no guarantees. But I think we\u2019re in a better place than we were.\u201d<\/p>\n

\u201cThis time it was Ebola. [Next time] it could be something else, another disease that pops up that we\u2019re not aware of at this point. This training has prepared us for whatever may come through our door that\u2019s an infectious disease.\u201d
Wanda Peebles, chief nursing officer at John Peter Smith Hospital in Fort Worth<\/div>
<\/div><\/div>\n

 <\/p>\n

Selected photos courtesy of The Dallas Morning News.<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

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